Large colorectal polyps: cold snare had about 70% fewer major complications but twice the residual adenoma

The edition in brief

An individual patient data meta-analysis of four randomised trials (1,509 non-pedunculated polyps of 20 mm or more, mean 31 mm) found cold snare resection had fewer major adverse events than hot EMR (1.7% vs 5.9%; OR 0.26) but more than twice the residual or recurrent adenoma (26.5% vs 12.8%; OR 2.61). The gap was smallest for sessile serrated lesions (15.0% vs 8.1%) and largest for adenomas with high-grade dysplasia (40.8% vs 18.0%). A 35-member international Delphi panel agreed that MASLD is associated with increased colorectal cancer risk and recommended greater vigilance and earlier, risk-adapted screening. In 22,537 US veterans with alpha-1 antitrypsin genotyping, major adverse liver outcomes rose with Z-allele burden: Pi*MZ HR 1.25, Pi*SZ 1.51, Pi*ZZ 1.80 against Pi*MM. A network meta-analysis of 13 randomised trials (4,156 participants) found AI-assisted colonoscopy modestly increased detection of diminutive polyps with very low certainty, and had minimal effect on polyps of 6 mm or more. The Rome V global survey of 28,771 adults in 15 countries found 40.9% met criteria for at least one disorder of gut–brain interaction, matching Rome IV.